Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for managing type 2 diabetes mellitus. Whilst its primary purpose is glycaemic control, many patients experience weight reduction during treatment. Clinical trials demonstrate that Trulicity typically produces modest weight loss, though the extent varies between individuals. It is important to understand that Trulicity is not licensed as a standalone weight-loss medication in the UK, and prescribing decisions should align with NICE guidance for type 2 diabetes management. This article examines the evidence for weight loss with Trulicity, who may benefit, and essential considerations before starting treatment.

What Is Trulicity and How Does It Work?

Trulicity (dulaglutide) is a prescription medication licensed in the UK for the treatment of type 2 diabetes mellitus. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone in the body that helps regulate blood sugar levels.

The mechanism of action involves several key processes:

• Stimulating insulin secretion from the pancreas when blood glucose levels are elevated

• Suppressing glucagon release, which reduces glucose production by the liver

• Slowing gastric emptying, meaning food moves more slowly from the stomach into the small intestine

• Reducing energy intake through effects on appetite regulation and satiety

Trulicity is administered as a once-weekly subcutaneous injection using a pre-filled, single-use pen device. It is available in four dose strengths: 0.75 mg, 1.5 mg, 3.0 mg and 4.5 mg, with treatment typically starting at the lower dose and titrating upwards as needed. The Medicines and Healthcare products Regulatory Agency (MHRA) has approved it specifically for glycaemic control in adults with type 2 diabetes, either as monotherapy when metformin is inappropriate, or in combination with other glucose-lowering medications including insulin.

Whilst Trulicity's primary indication is diabetes management rather than weight loss, the medication's effects on gastric emptying and appetite regulation often result in weight reduction as a secondary benefit. This has led to increased interest in its weight management properties, though it is important to understand that Trulicity is not licensed as a standalone weight-loss treatment in the UK. The National Institute for Health and Care Excellence (NICE) includes GLP-1 receptor agonists in its guidance for type 2 diabetes management, recognising both their glucose-lowering and weight-related effects.

How Much Weight Loss Can You Expect with Trulicity?

Clinical trial data demonstrates that weight loss is a common effect of Trulicity treatment, though the extent varies considerably between individuals. In pivotal studies, patients taking Trulicity typically experienced modest weight reduction ranging from 1 to 3 kilograms over 26 to 52 weeks of treatment, compared to baseline measurements.

The AWARD clinical trial programme, which evaluated Trulicity's efficacy and safety, showed that:

• Patients on the 1.5 mg weekly dose lost an average of 2 to 3 kg over six months

• Weight loss was generally greater with higher doses (the AWARD-11 trial demonstrated enhanced weight reduction with 3 mg and 4.5 mg doses)

• Results were dose-dependent, with the 4.5 mg dose producing average weight loss of approximately 3 to 4 kg at 36 weeks

• Weight loss typically occurred gradually over the first 6 to 12 months of treatment

It is crucial to recognise that individual responses vary significantly. Factors influencing weight loss include baseline body weight, dietary habits, physical activity levels, concurrent medications (particularly insulin or sulphonylureas), and metabolic factors. Some patients may experience minimal weight change, whilst others achieve more substantial reductions.

Comparative studies suggest that Trulicity produces less weight loss than some other GLP-1 receptor agonists. For example, the SUSTAIN-7 trial showed that semaglutide (Ozempic) achieved greater weight reduction than dulaglutide at comparable doses. Network meta-analyses and limited head-to-head data also suggest tirzepatide (Mounjaro) may produce more substantial weight loss, though direct comparison studies in UK populations are limited.

Weight loss should be viewed as a beneficial secondary effect rather than the primary treatment goal when Trulicity is prescribed for type 2 diabetes. Patients should maintain realistic expectations and understand that lifestyle modifications—including a balanced diet and regular physical activity—remain fundamental to achieving and maintaining weight loss.

Who Should Consider Trulicity for Weight Management?

Trulicity is not licensed purely for weight loss in the UK, and prescribing decisions should be made within the context of type 2 diabetes management. According to NICE guidance (NG28), GLP-1 receptor agonists like Trulicity may be considered for adults with type 2 diabetes when:

• They are already on triple therapy (typically metformin, a sulphonylurea, and another oral agent) but have inadequate glycaemic control

• They have a body mass index (BMI) of 35 kg/m² or higher (or lower thresholds for people from South Asian, Chinese, and other higher-risk ethnic groups)

• Insulin therapy would have significant occupational implications or weight loss would benefit other obesity-related comorbidities

• They are using insulin but have inadequate glycaemic control with a high BMI

NICE recommends continuing GLP-1 therapy only if there has been a beneficial response after 6 months (reduction in HbA1c of at least 11 mmol/mol [1%] and weight loss of at least 3% of initial body weight).

The medication is most appropriate for patients who:

• Have type 2 diabetes with inadequate glycaemic control on existing therapy

• Are overweight or obese (BMI ≥30 kg/m²)

• Would benefit from avoiding weight gain associated with some diabetes medications (such as insulin or sulphonylureas)

• Have obesity-related comorbidities including hypertension, dyslipidaemia, or obstructive sleep apnoea

Trulicity is not suitable for individuals with type 1 diabetes, diabetic ketoacidosis, or those with severe gastrointestinal disease, including gastroparesis. It is not recommended during pregnancy or breastfeeding, or for patients under 18 years of age.

For individuals seeking weight loss without diabetes, other medications specifically licensed for obesity management may be more appropriate. Your GP can discuss whether Trulicity or alternative treatments align with your clinical needs and circumstances. Weight management should always incorporate lifestyle interventions as the foundation of treatment, with pharmacotherapy serving as an adjunct rather than a replacement.

What to Discuss with Your GP About Trulicity

Before starting Trulicity, a comprehensive consultation with your GP or diabetes specialist is essential to ensure the medication is appropriate and safe for your individual circumstances. Key discussion points should include:

Medical history and cautions:

• Previous or current pancreatic disease (pancreatitis)

• Severe gastrointestinal conditions

• Kidney disease (renal function should be monitored)

• Diabetic retinopathy (rapid improvement in blood glucose can temporarily worsen retinopathy)

• Gallbladder disease (GLP-1 receptor agonists may increase risk of gallstones)

• Pregnancy planning (Trulicity is not recommended during pregnancy or breastfeeding)

Common adverse effects that patients should be aware of include:

• Gastrointestinal symptoms (nausea, vomiting, diarrhoea, constipation, abdominal pain)—these are the most frequently reported side effects, typically occurring early in treatment and often diminishing over time

• Reduced appetite, which contributes to weight loss but may be uncomfortable

• Injection site reactions (redness, itching)

• Hypoglycaemia risk, particularly when combined with insulin or sulphonylureas

Important safety considerations:

Patients should contact their GP urgently if they experience:

• Severe, persistent abdominal pain (potential pancreatitis)—if pancreatitis is suspected, stop Trulicity and seek immediate medical attention

• Symptoms of dehydration or acute kidney injury due to persistent gastrointestinal side effects

• Visual changes or worsening diabetic eye disease

• Unexplained, persistent nausea or vomiting

Practical information:

• Trulicity comes in single-use pre-filled pens (0.75 mg, 1.5 mg, 3.0 mg, and 4.5 mg)

• Treatment typically starts at 0.75 mg weekly, with potential dose increases based on response

• Store pens in a refrigerator (2-8°C); once removed, can be kept at room temperature (below 30°C) for up to 14 days

• Do not freeze; protect from light

• Proper injection technique and rotation of injection sites

Monitoring and follow-up: Your GP will typically arrange regular reviews to assess:

• HbA1c levels (glycaemic control)

• Weight changes and BMI

• Renal function (particularly in those with existing kidney disease)

• Tolerability and adverse effects

NICE guidance recommends reviewing GLP-1 therapy at six months, continuing only if there has been a beneficial metabolic response (reduction in HbA1c of at least 11 mmol/mol and weight loss of at least 3% of initial body weight).

Discuss your treatment goals, expectations, and any concerns openly with your healthcare provider to ensure Trulicity is the most appropriate option for your diabetes management and overall health objectives. Report any suspected side effects via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Frequently Asked Questions